I had a patient come back from the doc with an order..."Norco 1 tablet q4hours". So i called the office to clarify with a dosage. the doctor himself called me back and blessed me out and told me that Norco only comes in one dosage and thats why he writes the order that way...that it is 5/325. i argued with him that it had different dosages and he told me i was stupid.
I remember when we had one resident who came in with an order for Vicodin 7.5/750 2 tabs q6hours PRN.... and worse still, she actually watched the clock to make sure she was getting it exactly "on-time" and would call her daughter if it was even a few minutes late.
Well, the doctor was at a complete loss as to why we were upset - what was wrong with having 2 pain pills every 6 hours if that was what the patient wanted? He didn't understand we weren't concerned about the hydrocodone one bit - we were concerned about hepatic failure due to APAP toxicity!
This actually went on for a couple of days until the physician came to the facility (a SNF) for rounds. When I and another nurse showed him the order and added up the APAP content - a whopping 6 grams a day, 2 grams over the HIGHEST safe limit established by our protocols, he quickly changed her over to Norco 10/325, two tabs q 4 hours PRN. That made everyone happy - the patient was getting better pain control without destroying her liver, and we weren't living in terror of the family's wrath and being sued for poisoning Mom.